Giving Thanks

During this week of focusing on the gratitude engendered by the American celebration of Thanksgiving, I'd like to take a moment and give thanks for anyone and everyone connected with this blog, my work in nursing, my new avocation as a Nurse Coach, RN.FM Radio, and my many connections and networks.

An Unexpected Occupational Hazard: The Nurse Gets Rattled

At the rural New Mexican home where I do home-based nursing care, the pace of work and the 360-degree view of the mesas, mountains and sky is quite different from other nursing milieus. While home care may not always seem glamorous to those in the ICU, trauma or other specialties, sometimes things happen that make me realize how interesting this specialty can truly be.

And So It Was....

She breathed her last breath in her own home, surrounded by family, held in the bosom of love.

And so it was.

Happy Holidays To All!

To my beloved readers,

I want to take this opportunity to thank you all for your encouragement, readership, comments and obvious passion for the best in nursing and healthcare. It's my joy to continue to bring Digital Doorway to you as its eighth anniversary approaches in January of 2013!

Meanwhile, my coaching practice at Nurse Keith Coaching will be marching into its second exciting year, and I'm thrilled to be developing new programs and initiatives that will deliver even more benefits to nurses seeking self-renewal and enhanced wellness.

As I take a blogging break until the New Year dawns, please feel free to read my most recent newsletter for my year-end wrap-up.

Thank you for being here, thanks for returning time and again, and please come back and visit me in 2013!

With gratitude,

Nurse Keith

Of Tragedy, Courage, Compassion and Love

America has been in the grip of grief and shock since news of the senseless and violent massacre in Newtown, Connecticut. The loss of so many innocent children is difficult to comprehend, and we mourn with those who are bereft of their loved ones.

A Grieving Ode to Tina

With the recent loss of my 17-year-old dog just under a week ago, I am, of course, quite conscious of the issues of loss and grief once again. Whether it's human loss or the loss of a beloved pet, the pain can run deep as we ride the waves that grief delivers to our doorstep.

On Retreat

Dear Readers,

In our coaching practices, my wife Mary and I consistently talk about the importance of self care and personal well-being, and how crucial this is for us to be most effective out in the world. Without self care, we can't be at our best, and our energy is dissipated and less powerful.

At this time, we are choosing as a couple to "walk our talk" by going on retreat ourselves. We are taking several weeks to rest and rejuvenate away from the workaday world, and we'll return on February 21st.

Until then, I send you my best, and wish you a Happy Valentine's Day. Many blessings to you and yours, now and always.

NurseKeith

Seven Years of Digital Doorway

Well, it may seem like a blink of an eye at times, but Digital Doorway has been alive and well for seven years today, born from a simple suggestion by my prescient brother as we sat in front of the woodstove on a snowy New England night. I can hardly believe that so much time has passed since that January day when I dived headfirst into the blogging world with no idea of where I was going or, honestly, what I was doing.

When Digital Doorway launched, it was not clear to me that it would be a blog mostly about nursing. Although my online moniker at the time was indeed "Nurse Keith", I had no notion of branding, hadn't heard of SEO (Search Engine Optimization), and the blogosphere was an enormous and cavernous unknown.

Over time, Digital Doorway began to distill itself into a somewhat more cohesive entity, and 1520 posts later, it has become one of the more well-known blogs in the nursing blogosphere,. Yes, it's garnered a fair amount of attention and notoriety over time, although it's still somewhat small potatoes compared to the blogging giants out there. (You know who you are!)

Back in the day, I didn't know about keywords and never gave much thought to such things. In all actuality, I still don't write my posts with keywords in mind, and I just let my blog's relative influence online do the job. However, with hundreds of backlinks that point here to Digital Doorway, it's a given that my writing will have a moderate audience out there in blogland. That said, with my new mentors, colleagues and friends over at RN.FM Radio, keywords, SEO and such animals are now making their way into my lexicon and writing practice, and as we grow RN.FM Radio and its cousin LLC, Unbound Media Group, our presence online as coaches, bloggers and nurse entrepreneurs is sure to grow. And no doubt that Digital Doorway will itself benefit from that vertical and horizontal expansion.

As NurseKeith.com continues its slow and steady launch, Digital Doorway is becoming the repository of much more focused thoughts on nursing, the profession's present and future, new books on nursing. and the impact that coaching can have on nurses' lives, among other topics of note. I look forward to continuing to deliver quality content that's informative, timely, and easy to read (and perhaps periodically entertaining).

Thank you for supporting Digital Doorway. Thanks for reading, thanks for the many comments, for following me on Facebook and Twitter, and for the encouraging words I've received since launching NurseKeith.com.

Yes, it's been a long, strange trip, and I have a feeling 2012 will be no different. Come along for the ride, and let's see what the next seven years brings!

My Mother: Rest in Peace

On May 26th, just over one month ago, I posted a blog post entitled The Ride of a Lifetime in which I ruminated about life, death, mortality, and my own coming of age as an elder. In that post, I paid homage to my recently deceased father-in-law, my newly widowed mother-in-law, and my deceased step-father, whose ashes sit in a makeshift urn on my mother's kitchen counter.

Not sixteen days later, I received a phone call from my sister that my mother, a relatively healthy 78-year-old woman with several well-controlled chronic health conditions, had suffered a serious stroke. A Juilliard-trained classical pianist, my mother was giving a recital with some of her students that afternoon, and in keeping with her desire to "die while playing the piano" (as she had often wished), she continued to play with her right hand as she lost all control of her left. Rushed to the hospital, she lost consciousness in the ambulance and was declared brain-dead by early evening, a ventilator maintaining oxygenation of her vital organs while our family made some important decisions. My sister and brother-in-law held vigil at her bedside for almost 12 hours, friends coming and going, bringing food and offering solace and prayers.

Arriving to Atlanta from Albuquerque at 2am, I arrived to the hospital to join my sister and her husband at the bedside, and we made the mutual decision to disconnect her from life support. We held her hands as her heart slowly stopped beating, and the life force left her body completely at 5:15am. Knowing that she would never have wanted to remain "alive" artificially, this decision was relatively easy to make.

I stroked her hand for some time in those early morning hours, marveling at the smoothness of her skin and remembering with my fingers all of those arthritic knobs that never seemed to compromise her musicianship. She was a consummate musician, and she would be thrilled to know that her final act on this earth was playing the piano as she encouraged young musicians to pursue their dreams and develop their talents.

Losing one's mother is a loss like no other, and I'm still digesting the fact that she's gone. Writing is not easy for me right now, and thus my output here on Digital Doorway (and elsewhere) has slowed to a crawl. Meanwhile, my grief comes in waves, and while I rejoice for her freedom, I recognize and honor the loss that I and my other family members have suffered.

Here is a copy of the eulogy that I read at her memorial service on June 15th in Atlanta, Georgia. Rest in peace, Mom. I love you.

It will come as no surprise to anyone in attendance today that our childhood had a soundtrack. From Gershwin’s “Rhapsody in Blue” to Beethoven or our mother’s original compositions, the music flowed throughout our lives. Whether we were attending one of mom’s many concert performances, serving as her ersatz “bodyguards” at Jersey Shore nightclubs, or listening to her practice as we did our homework, the pervasive soundtrack continued as a constant reminder of both our mother’s musical genius and her passionate vocation.

But in as much as my mother’s life was informed by music (and our lives by extension), the other parallel soundtrack was one of love, kindness, and unconditional support. Especially in my adult years, it became ever more apparent how my mother accepted my many incarnations with unperturbed aplomb. Whether I was announcing my desire to study yoga, travel to Europe, marry a single mother, or attend nursing school, she and Tulane both reacted with similar equanimity and words of support and enthusiasm. (But I must admit the one-way ticket to London at age 21 was likely the most difficult thing for her to accept, let alone my 11-month absence long before the days of cell phones and email, not that my mom ever mastered the use of a computer!)

Nonetheless, support and caring were indeed the ingredients that were essentially my mother’s modus operandi when it came to her children’s and grandchildren’s endeavors, and she personified unconditional love in my personal experience of her, especially in the final years of her life.

In her four years as a widow, mom was lonely at times, of course, and I very recently noticed the marked joy and surprise in her voice when on the receiving end of a telephone call. “Keithie!” she would say with childlike joy, “How are you?” She would never fail to tell me what she’d most recently been up to (oftentimes repeating stories that I may have already heard, perhaps during one of her very long voicemail messages), but also never failing to ask “And how are Mary and Rene and Bevin and Tina?” (Referring to my wife, my son, my daughter-in-law, and my dog).

Characteristically, she showed as much as interest in the welfare of our dog Tina as she did in any of her grandchildren (sorry, kids!) but the reality seemed to be that she saw dogs and grandchildren as equals when it came to doling out her enormous affection and interest, and Tina was as deserving of her grandmotherly curiosity as any of the kids in the family.

As a mother, a grandmother, a musician, and, I must add, as my lifelong friend, my mother was a force of Nature. That said, it may take me some time to digest the fact that her unconditional support and love will no longer come in the form of newsy telephone calls, thoughtful cards, and those ubiquitously long voicemail messages. I’ll miss her voice, the way she listened so intently on the phone, and the way she would hold my hand so very tightly with her piano-strengthened fingers.

Like any death, hers brings with it great sadness, a modicum of regret, and the sense that a life well lived has been rewarded with the ultimate peace that God and Heaven offer, especially as I imagine her being welcomed by an angelic Tulane, her loving husband who left her only four years ago. I can just picture a heavenly host gathered around a snow white concert grand as Tulane cajoles her to play The Moonlight Sonata. She’ll oblige, of course, and the tip jar (generally an over-sized brandy snifter if it were left up to Tulane) will be overflowing with the blessings and prayers of those who love and adore this remarkable and elegant woman.

The Ride of a Lifetime

Over the last six or seven months or so, mortality, health and illness have played a significant role in my personal life, and led to many musings about these weighty and universal subjects.

On Thanksgiving Day of last year, my father was hospitalized for a mysterious set of symptoms that left him bouncing between the hospital, a rehab facility and a nursing home for the better part of two months, his life a combination of miseries that brought him to the very edge of his tolerance of discomfort and physical and emotional exhaustion. Luckily for him, he has greatly improved, and while some symptoms persist, he is now happy to be home and relatively independent at the age of 82.

Two months ago, a rather garden variety respiratory infection sent my wife to the local hospital (on our moving day, no less) with a very aggressive bacterial bronchitis. Luckily, her infection was treated equally as aggressively, and she was sent home within a few days and eventually recovered after much rest and recuperation. Still, it was a wake up call on many levels.

Then, out of the blue on May 5th, Cinco de Mayo (which also happened to be my father's 82nd birthday), my wife's father had a massive heart attack and died in the living room of the home he shared with my mother-in-law. Although the paramedics attempted to revive him for thirty minutes (he had no advanced directives to request that they not do so), I am 100% certain that he was dead by the time they arrived. He was a large man in both the physical and metaphysical sense, and the loss of his presence on this earth is reverberating in the lives of many, many people who loved and admired him.

Since my step-father's death four years ago from metastatic pancreatic cancer (a death over which my wife and I presided as midwives, of a sort), we have become acutely aware of how our parents are indeed aging, and how their health and mortality are coming to the fore as they enter the winter of their lives. Other friends who have lost their parents understand our position, and we have watched as certain friends have become the new "elders" of their clans as their parents' generation makes it's exit.

Several weeks ago, sitting at a restaurant in a town outside of Austin with my now widowed mother-in-law and assorted family members, I was acutely aware of how my brother-in-law and I were, in effect, the patriarchs at this long table, a table at which, by all rights, my father-in-law should have been seated at the very head. However, in his absence, my brother-in-law and I had no one to fight with over the bill, so we calmly took out our credit cards and split the bill 50/50, starkly aware of how "The Colonel" (as he was affectionately known) would have never allowed us to do such a thing if he had been there to seize the check for himself. (In fact, in order to ever pay the check for a restaurant meal, I would always need to pretend to go the men's room, surreptitiously slipping my credit card to the server in advance, a sneaky yet highly effective endeavor.) But I digress.

This continuous movement along the life-and-death cycle truly brings home the fact that death---just like life---is itself inescapable, and our time on this mortal coil is blessed indeed. With the happy knowledge that I will eventually be a grandparent, God willing, my heart sings with the notion of life continuing in the very face of death and decay.

Sitting here this afternoon on the porch of an elderly patient's home where I work 12-hour shifts twice per week, I watch the clouds roll across the deep blue New Mexican sky. I observe the movements of the wind, trees, sun, dust, and tumbleweeds across the wide open expanse that surrounds me with a 360-degree view. A small lizard scurries across the worn wood planks of the porch, two birds alight in the bird-feeder, and a horse whinnies in the distance. I am grateful for the life that I have been given, and for the choices I have made that have brought me to this very place.

I think of my father-in-law, his large body now reduced to a small box of ashes interred reverently in a military cemetery in Texas. I think of the ashes of my step-father, some of which sit in a decorative vessel on my mother's kitchen counter, and a container of which awaits a trip to the Italian island of Capri where I promised him I would one day scatter them to the Mediterranean winds. I think of friends who have died, one by murder, one by his own hand, and others from illness and disease. I think of another friend who is currently waging a battle with cancer.

Human life is a beautiful, fragile, precarious and wonderful gift, and many of us waste countless hours, weeks and years frittering our time away in worry, regret, recrimination and remorse. In the final analysis, it's the quality of your living and your giving that counts, not the number of CDs in your collection, the balance in your checking account, or the make of your car. We humans get caught up in such shenanigans, losing track of what's important as we mindlessly chase that which is ephemeral and meaningless. It can be a long way from birth to death, and sometimes it's a short ride indeed, but the quality of the space in between these mysterious processes is truly the issue to deeply consider.

I have firmly and unequivocally entered middle age, and as my 50th birthday approaches in only three years hence, I look back and examine my life, realizing that it is likely more than half over. Regret is neither my friend nor my companion, and I realize that in order to honor the dead who have gone before me, it is my righteous duty to take this life by the horns and live it with the fiercest love and grace that I can muster. That is the greatest gift that I can give to myself, and it is the most fitting tribute to those who have moved on from this life to the next.

Our mortality is, in the end, one of the things that make living a fulfilling life so urgently sweet. Our time is limited, there's much to do and see, and there are hearts to touch and people to love along the way. Moving forward is indeed the only option, even when those we love leave us behind to wonder what is beyond that ethereal veil through which they have passed. I want my life to be a testament to what I love and what I value, and I believe that I am on the right path. I am grateful for my time on this earth, and I want to always rest in the knowledge that, despite the pain and suffering, it was truly the ride of a lifetime.

Compassion From Day to Day

I find that my days are simply filled with opportunities for feeling compassion for others. Consequently, it is those moments when I can connect with my compassion when I feel most connected, optimistic and part of something bigger than my little life.

As a nurse, one can often be consistently confronted with chances to be compassionate. In fact, nurses are often rated in surveys as some of the most trustworthy and compassionate people around, so I see my vocation as a professional doorway to practicing "compassion in action".

Working one-on-one with an elderly gentleman who lives with a variety of complaints and ailments, I use my compassion to see his suffering as no different than mine, and I strive to be free of judgment and frustration when he refuses to do what I think might be in his best interests. My frustration does bubble up from time to time, but I try to see the world through his blurry eyes, and I cultivate a gentle acceptance of his personal modus operandi.

In my other work, a woman with a history of a major stroke can say nothing more than "momma" over and over again, although we are aware that her mental and cognitive functions are fully intact. She frequently cries in frustration when she cannot make herself understood, and I do my best to look her deeply in the eyes and beam my love and admiration to her when we are face to face every other week when I come to see how things are going with the home health aides that I supervise. I think she and I have great love for one another, and although we cannot communicate conversationally like we might like to, we connect on a level that supersedes that of the spoken word.

Yet another client has a condition that puts her at great risk of repeat heart attacks or strokes, and she lives each day as if it might be her last. Her condition is uncorrectable, and although medications keep her alive, she walks a precipitously tenuous line with life on one side and death on the other. We talk deeply about her life, her past, and her fears for the future, and I listen to her with an open heart and a well of compassion for her suffering.

Aside from nursing, opportunities for compassion are everywhere: the homeless veteran begging for money on the street corner; the elderly widower making his lonely way through his latter years; the child home from school with the flu; a friend who loses a parent.

The human condition is almost synonymous with suffering, yet that suffering can be assuaged on many levels by the active practice of compassion for others, and the ability to see the suffering of another person as no different than one's own. "There but for the grace of God go I" is a crucial tenet to remember at time when one feels judgmental or impatient with the plight of other people, and it is in cultivating such an outlook that we truly embody our humanity.

One Year Wanes, and Another Dawns

Well, dear Readers, yet another year in our lives has slipped through the fingers of time, and we pause to consider our blessings, count our lucky stars, and plan for the New Year ahead.

For me, this has been a year of great and momentous change. As most of you know, in October of 2009, my wife Mary and I sold our house and most of our possessions, left our beloved New England, and hit the open road in a 29-foot mobile home in search of intentional community. We chronicled that journey on our travel blog, Mary and Keith's Excellent Adventure, and in the course of our travels we visited more than 30 intentional communities in seven months.

Since June, we are settled---at least for now---in a lovely cohousing community in Santa Fe, New Mexico. Looking back, we readily acknowledge that everything we set out to accomplish has been realized: we live in a multigenerational intentional community with many like-minded souls, we are nearby to our son and daughter-in-law, our financial lives are more secure, we work less, we play more, and our quality of life is vastly increased. Speaking of counting one's blessings!

While we are uncertain of what the future holds, we currently have good health, a sense of belonging, a new coaching business, and there is a renewed sense in our lives that just about anything is possible.

As a nurse, I have two part-time jobs that are relatively non-stressful, allowing me more time to develop myself as a coach and as a professional writer. The nursing profession has been kind to me, and I relish being able to pick and choose the positions that are most suitable for me.

For this New Year, I wish all of you much success, health, abundance, love, prosperity, and a sense of peace in your hearts. Thank you for making Digital Doorway what it is, and I look forward to celebrating this blog's sixth anniversary with you next month.

Happy Holidays, Happy New Year, and my blessings to you and yours, now and always.

NurseKeith

Pondering Loss, Gratitude and Life

Having recently celebrated The Day of the Dead here in Santa Fe, I have been acutely aware of the power of loss in recent weeks. The celebration of the Day of the Dead in both the Southwest U.S. and Mexico brings the notion of death and loss into the light of day. This time of year is seen as a period where "the veils between the worlds" are somewhat thinner, leaving the dead and the living in closer proximity to one another.

That said, Autumn is often a time of loss for many of us. We grieve the death of Summer, the death of the warmer weather (if we live in an area with normal changes of season), and we either embrace or resist the coming Winter and the more internal hibernatory nature of the colder months.

For me, this Autumn certainly brings with it a sense of loss as Summer wanes and Winter begins to take hold. It also brings to mind past losses and future losses yet to be.

One year ago, my wife and I pulled up stakes in Western Massachusetts, sold most of our belongings, and set out on the open road in a used mobile home that we purchased as our ticket to freedom. That leave-taking was difficult after twenty rich years of life in one place, but it seemed like the right time to leave, and we seized the moment.

Not two weeks after our departure, a dear friend took his own life, forcing us to return to New England in order to mourn his sudden death. This week marks the one-year anniversary of his last desperate and violent act, and the falling leaves and chilly air conjure images of a cold November day last year when thirty of us stood outside the barn where he had hung himself, sharing stories of our dear friend David.

Now, another friend on the East Coast is battling metastatic ovarian cancer, and her poor prognosis and continuing decline give us pause as we note her long-standing importance in our lives and the distinct possibility of losing her.

As I write this post, my eighty-year-old father (who was, by the way, loathe to celebrate his 80th birthday for fear of what this new decade would bring) is beginning what seems to be a slow decline, showing signs of early Alzheimer's, physical weakening, and a general diminishing of the childlike and optimistic spirit that has been his lifelong calling card.

Just this afternoon, a neighbor underwent surgery, and although she is young, healthy and vibrant, it is yet another reminder of the transient nature of our bodies, and the risks we all run by simply being incarnate human beings.

I am grateful for this life, for the people and animals who inhabit it, and I am again and again reminded how, by the grace of God, I continue to be a healthy and intact person who has a roof over his head, money in the bank, food to eat, clothes on my back, a car to drive, and an abundance of loving people around me. It is no small miracle, and the ubiquitousness of loss and death are yet another reminder of just how lucky I truly am.

As David's spirit continues on it's journey and as our dear friend grapples with the cancer that may eventually end her life, I am cognizant of my own continued blessings and how they are not to be taken for granted.

The mysteries of life are legion, but the importance of appreciating that mystery trumps every petty complaint and worry that crosses the mind. For me, the greatest lesson is the need for consistent gratitude, even in the face of loss and grief. It is a steep learning curve, yet one well worth the effort and energy to surmount in the hopes of experiencing peace, acceptance, and the knowledge that life is a gift never to be wasted.

Of Birthdays and Death

Celebrating my 46th birthday this week has been a wonderful exercise in being grateful for all of my blessings, and the need to take grateful stock of my life is underscored by the persistent presence of sickness and death that is such an intrinsic part of human existence.

As a nurse, I have worked with the dying and the chronically ill for many years, and their struggles are a reminder that our hold on this mortal coil is tenuous, at best. Several years ago, my wife and I spent about three weeks living at my mother's house in New Jersey, caring for my step-father as his body slowly diminished in its power and presence at the hands of pancreatic cancer. Presiding over his dying process and his death was a powerful and moving experience, and despite my many years of nursing, his was the first death that I witnessed firsthand. That last gasping intake of breath was profound in its finality, even as we waited for the exhalation that never came. I noted how quickly the life force left the body, and how quickly we shifted from care-taking to grieving in the space of one breath.

In 2001, a very close friend of our family was gunned down by the police in a circumstance that might be plausible in a movie or novel, yet was wholly unreal to those who witnessed it and those who survived his horrible passage from this world to the next. Distressed, he had called our home to solicit our assistance moments before the police burst in and riddled his body with seven bullets, and we heard his dying cries of love on our answering machine as he lay bleeding. His death was indeed something almost beyond belief, and the post-traumatic stress that followed was life-altering.

Last year, a dear friend took his own life after years of struggling with chronic pain, depression, and an undiagnosed cognitive condition that robbed him of the ability to use his brilliant brain in the way in which he was accustomed. Memory failed him, words were slow to come, and the loneliness that he experienced was simply too profound for him to see a way to continue on. His 51st birthday would have been last Friday, and I miss the opportunity for him and I to celebrate our August birthdays together, Leos in heart and spirit.

Another close friend was diagnosed with an advanced cancer a few months ago, and this shocking news of urgent surgery, treatment and the potential for death from the ravages of the disease were yet another wake-up call. She is literally fighting for her life while she also faces her own mortality square in the face with courage and understanding that our time on this earth is indeed limited, either by illness, fate or irreversible circumstance. She is a shining example of grace and courage in action.

The other day, it was revealed that a close friend's sister died suddenly at 42, leaving a young daughter without a mother and a confused group of family members and friends. Sudden death is perhaps the most difficult to digest and understand, but acceptance is still the eventual goal, no matter how challenging the path to that state may be.

So, birthdays come and birthdays go, and we move forward in our lives with our petty complaints, our desire to do better, and the courage to continue on even in the face of monumental loss and grief. Birthdays are indeed a time for celebration, but they are also a moment for reflection, atonement, and the realization that this very birthday may very well be our last.

In light of that reality, why then do we waste such precious time with the minutiae of our complaints, problems and apprehensions? This is one of the puzzles of human life, and perhaps this year I will learn even more deeply that my time on this earth is limited, that these days are precious beyond description, and that it's time to live life without regret and hesitation. Perhaps this is the year when I will realize the enormity of the gift, embracing life with the open-eyed wonder that its many mysteries deserve. Happy birthday indeed.

Fingerprints, Ad Nauseum

Since coming out West, it seems that I can barely do anything at all pertaining to medicine or nursing without having to get my fingerprints taken.

When I applied for my Texas nursing license, I obediently went to the local sheriff's department near my in-laws' home in Georgetown and had three FBI fingerprint cards done by a clerk who seemed relatively uninterested in the proceedings.

Six weeks later, I received notice from the Texas Board of Nursing that those prints were poor quality and unreadable (no surprise there), and was thus requested to have them done yet again. Since my wife and I were traveling at the time, I stopped into the court house in Silver City, New Mexico where a friendly but overworked sheriff's deputy expertly took my prints and sent me on my inky way. (Those prints were subsequently accepted and I received my Lone Star State license soon thereafter.)

Following my licensing fingerprint debacle, I applied to be a board member of a new medical marijuana clinic in northern New Mexico (they needed a nurse on the board), and of course, yet another set of fingerprints was demanded for the privilege of applying for membership. Still traveling, I stopped into the Sedona, Arizona police station where friendly volunteers happily collected my money and greased up my fingers yet again.

Now, having settled in Santa Fe, New Mexico, I have applied for several nursing jobs, and each of those positions requires a set of fingerprints to be sent to the FBI, and these sets were luckily simultaneously taken on an electronic machine that creates a digital facsimile that can be transferred to paper.

Maybe it's just me, but there appears to be an enormous waste of resources involved in sending multiple individuals for repeat fingerprint screenings ad nauseum. When one considers the human hours wasted, the gasoline burned, the reams of paperwork filed and the extraordinary effort and energy expended in the name of bureaucracy, perhaps there's some addiction to bureaucratic chaos (a la the Terry Gilliam film, Brazil) that precludes the powers that be (local, regional, state and national) from creating a central database in which each individual's fingerprints could be simply recorded once.

I'm sure there are those whose trust in the government has waned to the point at which even submitting to fingerprinting in the first place would seem absurd at best (and dangerous at worst), but since I've already allowed my personal information to be submitted to the FBI innumerable times, I would thus have few qualms allowing my prints to finally sit in an electronic repository for access by potential employers and others interested to know that I am indeed who I say I am.

With these latest sets of prints behind me, I have no doubt that I'll once again be visiting the state police or a local sheriff when the next demand for fingerprints rolls around. Til then, I'll give thanks that my spate of fingerprinting adventures is over for now, and my ink-stained digits can finally rest on their (positively identified) laurels.

Jobs Galore

After living here in Santa Fe for just under two weeks, it seems that Craig's List has provided exactly what I needed in terms of part-time work as a nurse. Even when the local newspaper demonstrates a dearth of open positions, online sources of job postings are apparently where employment can be found.

Now, after the byzantine process of obtaining my Texas nursing license (our permanent domicile is currently in Texas), jobs here in New Mexico themselves provide a plethora of hoops through which to jump in order to receive that first paycheck. From having to obtain yet another set of fingerprints to having to take several different exams to further (and unnecessarily, in my opinion) test my knowledge of nursing practice, obtaining employment as a nurse here in the Wild West entails a labyrinthine to-do list that threatens to eat up leisure time like there's no tomorrow.

Still, finding remunerative and (hopefully) satisfying work is very nice, and I'm grateful to have made it through the application and interview processes relatively swiftly. My new jobs should prove to be interesting and relatively well-paying (but less than my previous hourly wages as a nurse in Massachusetts), and I hope that the experiences are also fecund fodder for blogging and writing (with complete adherence to HIPAA, of course!)

Working as a nurse again will be interesting after such a long hiatus, and I look forward to writing about the experience as it unfolds, so stay tuned.....

Licensed by the Lone Star

It's finally official. My nursing license from the state of Texas has arrived! Having been on the road for seven months, I have had the blissful experience of not needing to punch the clock, and the only paid work I have been doing has been writing content for BlackDoctor.org and Working Nurse Magazine.

Now that we will be suspending our travels and spending the summer in Santa Fe, New Mexico, it's time to look for work, float my resume, and translate that new license into action and income.

Some of you may wonder how I can work in New Mexico with a Texas license, and the answer is quite simple. A licensure compact exists between 24 states of the US, allowing for reciprocity between each state for nurses who hold a current license in one of those jurisdictions. With my legal domicile in Texas and my current (perhaps temporary) living situation in New Mexico, this licensure compact makes earning money and finding work much easier, a fact for which I am extremely grateful.

Having my new Texas license is a goal I have been moving towards for months, and I feel gratified that I have finally completed the lengthy application process. The job market for nursing positions is tighter than one might surmise, so having that license in hand is one of the important steps in enabling myself to pound the virtual pavement and find meaningful and remunerative work that utilizes the skills that I have honed for more than 15 years.

Stay tuned as the itinerant nurse searches for work in his temporary New Mexican home!

Rabies!

Today, while walking in the outskirts of Silver City, New Mexico, I was charged by a trio of dogs, one of whom managed to bite me on the inner thigh as I tried to turn and walk away from their barking ferocity. Normally a dog lover ( I have a dog myself), I am rarely frightened by dogs and generally have a way with them, but this triumverate were none too friendly, and I limped back to our campground as I called my wife on her cell phone and asked her to boil some water and ready the First Aid kit. (My wife and I have been traveling in an RV for six months, chronicling our adventures on our travel blog.)

Here's a photo of my wound.....


Interestingly, the Silver City Animal Control Officer was reluctant to come to see me at the campground, although he indeed paid a visit to the dogs' owner, who accused me of trespassing, a conclusion which I summarily rejected as false. Trespassing or not, a loose dog without a collar, identification or civilized manners had charged me and managed to sink a few teeth into my tender flesh, and the only thing truly on my mind was rabies.

According to the CDC (and most other authorities on the matter), if a person is bitten by an animal whose rabies vaccination status cannot be determined, that individual should receive a series of five rabies vaccinations (Post-Exposure Prophylaxis, or PEP) beginning on the day of the bite (also referred to as "Day Zero"), followed by vaccines on days 3, 7, 14 and 28. Rabies immune globulin (RIG) should also be administered as a second vaccine on Day 0, with up to half of the RIG vaccination injected into the tissue surrounding the site. Rabies is a serious illness with serious consequences, including contractions, high fever, confusion, agitation, coma and death.

As one can imagine, aside from administering First Aid to the site, and flushing it with hot soapy water and hydrogen peroxide, identifying whether or not a rabies vaccine series was necessary was first and foremost in my mind. Luckily for me, once we involved the local Sheriff's department in the case, we were informed within two hours of the incident that the canine in question was indeed up-to-date on his vaccinations, a conclusion that was obviously a happy one for us travelers.

Needless to say, dear Readers, rabies is a serious illness and must be taken seriously. If you or someone you know is bitten by an animal of unknown origin or vaccination status, prompt First Aid and rabies Post-Exposure Prophylaxis is paramount. Act quickly, seek medical attention, and be sure to follow all recommendations for treatment of such an injury, and you will be happier and healthier for it!

Learning From Pain

Living with chronic pain is like living with a psychic hitchhiker who never pays for gas or food. Pain comes along on vacation, but never picks up the tab after an evening at the night club. Pain robs one of ambition and drains the energy out of the day.

Pain is also a teacher, and we can learn to use our pain as a focus point for learning and growth. Yes, the pain can dog us throughout the day, but we can rise above it, ignore its desperate calls for attention, and even experience moments---perhaps even minutes or hours---without being conscious of its determination to be heard.

My pain is a nagging sensation along the right side of my spine, sometimes coiled there like a viper, at other times stretched out, enjoying its ability to take up space, coercing other nearby muscles to join the party. It doesn't move around much, but it has some contacts in other areas of my personal geography, and sometimes they chat and collude together. When the pain is more dispersed, my discomfort and unhappiness can grow exponentially, and the pain seems to thrive on my misery.

Sometimes, I realize that I haven't been conscious of any pain for minutes on end, and at other times I'll notice that it's been hours since I felt any pain. These are moments for celebration, and my deepest wish is to string together periods like this so that, eventually, I have entire pain-free days.

This morning, it's like a metal rod has been surgically implanted along the right side of my spine, and even if I stretch and pop a few vertebrae, the pain does not relent. Still, I expect that there will be moments and minutes today when I won't even notice it, when I am so enraptured with what's in front of me, leaving no space in my consciousness for something as measly and undeserving of attention as pain.

My pain gives me pause, makes me focus on my body, bringing me into the moment even when that moment is not a pleasurable one. Pain sharpens my awareness, reminding me of my corporeal reality, and can sometimes be a window into the suffering of others.

Several months ago, a dear friend of mine took his own life, partly due to unrelenting back pain that no doctor or healer could explain or assuage. My pain is similar, in that it cannot be identified or quantified by x-ray or MRI, and only one healer has had even a modicum of success in temporarily relieving it.

I understand my friend's motivation to end his own suffering and finally be without pain, but I am determined to beat the pain at its own game, turn it on it's head, show it who's boss, and leave this life naturally when my time comes, having lived a full life, undeterred by something as selfish and decrepit as pain.

Pain will not control me. It may limit my activities and make me think twice when there's wood to chop or water to carry, but it will not lead me deeply down those darkest roads of self-pity and fear. Yes, I have walked those roads and they are not pretty, but those are temporary visits, and I return to the light once more.

Pain is indeed a good teacher, and it is teaching me that life is for the living, and pain simply will not stand in the way of a life well lived.

2010: Cultivating a New Garden

It's a new year and a new decade, and with 2009 behind me, I am thinking about what qualities I would like to cultivate in this new year. Here is a list of what comes to mind on this blustery January 1st in rural southwestern Georgia:

Patience
Optimal health
Tolerance
Kindness
Eloquence
Service
Clarity
Perseverance
Trust
Faith
Abundance
Compassion
Understanding
Love

This list could go on forever, but the true rebirth of the New Year is in knowing deep within me that all will be well. So often, I walk in fear, worried for the future and fretting about the past, all the while missing out on the glorious present. I want to reject regret, forget about worry, forgive myself for fretting, and simply allow myself to live in the moment and embrace the present for the gift that it truly is. This is one of my greatest growing edges in this life, and my hope is that 2010 will be the year when I finally embrace the challenge and truly "get it". This is my hope, and I am sharing it here in this public venue in order to make it more real, and also to be held accountable as the year progresses.

Happy New Year to all, and may the newness of the year bring myriad blessings upon you and yours.